ENSURING FOOD SAFETY : AN IMPORTANT CHALLENGE TODAY

DR.JAMAL UDDIN CHOWDHURY

MEMBER, CENTRAL EXECUTIVE COMMITTEE

BANGLADESH MEDICAL ASSOCIATION

INTRODUCTION Food safety is a scientific discipline describing handling, preparation and

storage of food in ways that prevent food borne illnesses

It includes a number of procedures that should be followed to avoid

potentially severe health hazards

It includes the origins of food including the practices related to food labeling,

food hygiene, food additives, pesticide residues as well as policies on

biotechnology and food and guidelines for the management of governmental

import and export inspection and certification systems for foods

Food can transmit disease from person to person as well as serve as a growth

medium for bacteria that can cause food poisoning

WHO’S FIVE KEY PRINCIPLES OF FOOD HYGIENE

Prevent contaminating food with pathogens spreading from people, pets

and pests

Separate raw and cooked foods to prevent contaminating the cooked

foods

Cook foods for the appropriate length of time and at the appropriate

temperature to kill pathogens

Store food at the proper temperature

Do use safe water and raw materials

FOOD DEFENSE

Food defense : It is the protection of food products from intentional

contamination or adulteration by biological, chemical, physical or

radiological agents. It addresses additional concerns including

physical, personnel and operational security. The events may be

industrial sabotage or terrorism

Food protection is the umbrella term encompassing both food safety

and food defense

Ensuring Food Safety: An Important Challenge

Today*1

Jamal Uddin CHOWDHURY1

JMAJ, December 2015—Vol.58, No.4 145

Special Feature: Th e 30th CMAAO General Assembly & 51st Council Meeting

Symposium “Ensuring Food Safety: An Important Challenge Today”

[Bangladesh]

*1 This article is based on a presentation made at the Symposium “Ensuring Food Safety: An Important Challenge Today” held at the 30th

CMAAO General Assembly and 51st Council Meeting, Yangon, Myanmar, on September 23-25, 2015.

1 Central Executive Committee, Bangladesh Medical Association (info@bma.org.bd).

Newspaper Cuts Regarding Adulterated Food

“Hardly Anything Safe to Eat”

The Daily Star

Recently newspaper reported that rice prepared from plastic materials and artificially prepared eggs are marketed in Bangladesh which are imported items

Scrupulous merchants are using-

engine oil in the preparation of food Urea in preparation of puffed rice

Source: Bangladesh Statistical Year Book 2010

FOOD SAFETY SITUATION IN BANGLADESH CONTD. RISK FACTORS ASSOCIATED WITH FRUITS AND VEGETABLES

Microbial contamination:

E. coli, Helminths, Klebsiella, Enterobacter etc.

Chemical contamination

a. Pesticides residues

b. Artificial ripening agents: Calcium Carbide,Ethrel

c. Preservatives: Formalin

d. Environmental contamination: From polluted

water during washing

OUR CONCERN

Adulteration or intentional addition of illegal agents is mostly due to unethical trade but a lack of knowledge also contributes to some extent

Contamination along the food chain is mostly due to not following good practices from production level to consumption

FOOD SAFETY SITUATION IN BANGLADESH

WHAT IS OUR CONCERN

1. FOOD ADULTERATION

2. FOOD CONTAMINATION

MICROBIOLOGICAL CONTAMINATION

PESTICIDE RESIDUES

MYCOTOXINS

VETERINARY DRUG RESIDUES

HEAVY METALS

FOOD SAFETY SITUATION IN BANGLADESH RISK FACTORS ASSOCIATED WITH FISH,MEAT,POULTRY AND THEIR PRODUCTS

Microbial contamination:

Salmonella, Clostridia, E.coli, Vibrio,Compylobacter,listeria,H5N1,Anthrax,TB,T Saginata etc.

Chemical contamination:

a. Antibiotic: Tetracycline, Chloramphenicol, Nitrofuran,Veterinary Medication etc.

b. Hormone used for fattening

c. Environmental contaminants: Heavy metal like chromium(from feed- using hide and skin from tannery industries)

d. Pesticides: DDT (particularly for dry fish), , Aflatoxin

e. Preservatives: Formalin

f. Colouring matters: Particularly textile dyes

Physical contamination: Filths, darts

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CONTD…..

Process contaminants :

During heating or fermentation nitrosamines, polycyclic amines, histamine,acrylamide,furan,benzene trans fat,monochloropropanediol,semicarbazide,4-hydrxynineal(4-HNE),ethyl carbamate etc are produced. Heating processes that induce a surface dehydration of the food such as frying or oven baking process gives rise to appreciable acrylamide production.

Acrylamide also occurs in many cooked starchy foods such as potato chips,French fries and bread that has been heated.

Acrylamide is indicted for its carcinogenecity,neurotoxicity and reproductive toxicity.

CONTD…..

ii. Lead

Lead is stored in bones but it is in equilibrium with the lead present in blood. In Bangladesh,lead poisoning in young children is alarming.Chronic exposure to lead may result in anaemia,neuropsychological disorders in young children.

iii. Mercury

Mercury tends to bioaccumulate as methyl mercury in the food chain.Seafoods seem to be contaminated at a higher level.exposure to foetus may cause serious brain damage.Tuna fish is a particular concern.Recent high use of Compact Flourescent Lamp(energy saving bulbs)and its injudicious disposal in soil is also a concern.

CONTD….. 2. Inorganic

i. Arsenic

Arsenic can enter into plants from soil. The terrestrial plants can accumulate a large amount of arsenic. On the other hand, marine plants and animals have arsenic detoxification system

In Bangladesh, water is contaminated by arsenic widely. Almost one in five tubewells is not providing safe drinking water.About 20 million people in Bangladesh are using tubewells with more than 50 ppb of arsenic. Arsenic is found in rice also in endemic areas. There are now almost 66000 patients with Arsenicosis in Bangladesh.

Long term exposure to arsenic can cause cancer of skin,lungs,bladder and kidney and in children impaired cognitive development.It also causes disfigurement which ultimately creates social problem especially for women

Death by Cause in 2006 in Bangladesh (%)

Accident and Related, 10.04, 10%

Asthma and Related, 17.57, 18%

Infectious Disease, 10, 10%

Indirect Food and related Complcation,

21.54, 22%

Foodborne Illness, 23.58, 23%

Old Age, 17.27, 17%

Source: Statistical Yearbook of Bangladesh 2010, Chart percentages represent detail cause below: 23%(food borne illness): Liver diseases, jaundice, diarrhea, dysentery, TB, peptic ulcer, malnutrition, skin diseases, leprosy, arsenic, kidney, appendicitis, warm and other, 22%(indirect food and related): heart disease, stroke, blood pressure, diabetes, paralysis, tumor, cancer, 10%(infectious diseases): Chicken pox, measles, polio, fever, malaria, typhoid, influenza, diphtheria, meningitis, tetanus, gonorrhea, HIV, 18%(Asthma and related): Asthma, respiratory diseases, rheumatic fever, rheumatism, ENT diseases, 10%(Accident and related): suicide, murder, burn, snakebite, poisoning, drowning, rabies, mental diseases, drug abuse, epilepsy, pregnancy and abortion problem and the rest17% old age

Unsafe Food Creating Burden On Public Health

Diarrhea About 3 million cases reported/Year (Health Bulletin 2013 : 2.6 million) Responsible for 15% of mortality in children under 5 years

(Health Bulletin 2013 : 45/1000 live birth) Among the Top 10 diseases in Upazilla and District Hospital ,No. 1 is diarrhea

(Health Bulletin 2013)

Typhoid

17.74% and 12.24% of top 10 diseases in Upazilla Health Complex and District Hospital (Health Bulletin 2013)

Hepatitis A and E

Long term health effects Renal failure, Liver damage, Cancer

BRIEF OVERVIEW OF THE CONTAMINANTS

Environmental contaminants – industrial processes emit several thousand of inorganic

and organic chemicals. Due to this emission, agricultural commodities and thus also our food

may become contaminated

1. Organic – most important is dioxin and dioxin like compounds(DLC). People are exposed to

these although at low levels, particularly by eating animal fat in meat, diary products and

fish. Now a days it is said that plastic water container emits dioxin if kept in heated or

chilled environment. Dioxin or DLCs cause skin damage, cancer, NIDD in adults, neurological

and immune system impairments in infants and endocrine system disruption

ENSURING FOOD SAFETY: AN IMPORTANT CHALLENGE TODAY

JMAJ, December 2015—Vol.58, No.4 147

Different Policies Related to Food Safety National Agriculture Policy 1996

New Agricultural Extension Policy 1996

National Fisheries Policy 1998

National Food and Nutrition Policy 1997

National Food Policy 1996

National Health Policy 2000

National Livestock Policy 2007

Product Labeling Policy 2006

National Policy for Safe Water and Sanitation 1998

Import Policy 2009-2012

Export Policy 2009-2012

National Plan of Action for Nutrition 1997

Governance Stage

Purpose and procedures Implementation Status in the UK and EU

Implementation Status in Bangladesh

Framing:Governance design as per laws, regulation, Institution, resources

Setting terms of reference, procedure and focus using, e. g., law, institution, regulators

Full implementation undertaken using, for example, up to date law,coordination by regulators, guidelines, and resources

Partially exercised without defining goals as governance model Gaps:No governance design, backdated law, no single regulator, coordination gaps, resources gaps

Assessment Step 1:Screening Step 2:Prevention, precaution, concern or risk based assessment

Gathering knowledge by identifying risks using, e. g. sound science, or by social scientists or economists

Implementation undertaken except concern based assessment to be undertaken by social scientists or economists.

Partial implementationproved to be non-effective Gaps: Science based screening, and Testing labs non-functional,precaution, concern and risk based assessment gaps

Evaluation (Assessment decisions are evaluated)

Value-based judgment e. g. on tolerability or acceptability prior to management decision

Moderate implementation and full implementation is in experimental stage

Absent and not exercised as governance process Gaps: Evaluation gaps

Management Stage 1:decision making Stage 2 Implementation Stage 3 Monitoring

Selection of appropriate food safety risk decision by Management Board or regulator and decisions are based on prevention, precaution, concern or risk analysis.

Full implementation undertaken

Partially undertaken without setting proper goals and thus non-effective Gaps: No single management body or regulator, hence decisions are taken by different agencies piecemeal basis and no coordination

Governance Gaps in Bangladesh as per Global Model

AfnA

GOVERNANCE ISSUE MAIN MINISTRIES AND AGENCIES INVOLVED IN FOOD

CONTROL

Ministry Agency / Department

Ministry of Food -Bangladesh Food Safety Authority -Directorate of Food

Ministry of Local Government, Rural Development and Cooperatives

- Municipalities - City Corporations

Ministry of Health and Family Welfare - Directorate General of Health Services

Ministry of Industries - Bangladesh Standards and Testing Institution - Universal Salt Iodization Project, BSCIC

Ministry of Fisheries and Livestock - Department of Fisheries - Department of Livestock Services

Ministry of Finance - Department of Customs

Ministry of Agriculture - Department of Agricultural Extension

Ministry of Establishments - Executive Magistrates (Mobile Courts)

Ministry of Science and Technology -Bangladesh Atomic Energy Commission -Institute of Food Science and Technology, BCSIR

CONTD…..

Furan is found in cooked or heat-processed foods such as canned meat, baked bread, cooked chicken, caramel and coffee. Derivatives of furan are used as flavouring agents in food and tobacco products. Cancer, liver toxicity is detected in lab. Animals

Food additives and processing aids :

Calcium carbide and ethrel is used as ripener in fruirs. Calcium carbide in contact with moisture produces acetylene which is analogue of natural ripening hormone ethylene. Acetylene reduces oxygen supply to the brain. In acute stage it causes headache, vertigo, dizziness, seizure and even coma. In the long term, mood disturbance and loss of memory.

Prev

entio

n

Decision-making

Implementation

Food Safety Governance Framework

Conc

ern

Prec

autio

n

Risk

Monitoring

Prev

entio

n

Prec

autio

n

Conc

ern

Risk

Participation and Communication

Screening

Framing

ReviewReferral

Terms of References

Evaluation

Tolerablity and Acceptability

Judgment

AssessmentManagement

Global Governance Model for Food Safety (General Framework)

Source: Marion Dreyer and Renn Ortwin, Food Safety Governance: Integrating Science, Precaution and Public Involvement( Verlag: Springer, 2009), 1-10

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FOOD-BORNE ILLNESS SURVEILLANCE

Very little data are available IEDCR(Institute of Epidemiology,Disease Control and

Research) has developed a Food born illness surveillance system

Based on Recent food safety emergencies management

Anthrax (2010) Nipah outbreak (2010,2011) Hepatitis E & A ( 2010) Contaminated Litchi poisoning (2012)

Food Safety Emergency management plan developed

PESTICIDE AND VETERINARY DRUG RESIDUE ANALYSIS

HPLC

GC-MS

GC

LC-MS/MS

FOOD ADULTERANTS, COLORS AND DYES

NATIONAL FOOD SAFETY LABORATORY

Sample preparation laboratory Microbiology laboratory

HEAVY METAL ANALYSIS

Atomic absorption spectrophotometer

FAO Report,2010 On Food Safety Management System in Bangladesh

Areas Status

Food laws and regulations -New Food Safety Act enacted -Rules and regulation need formulation

Food safety management system -Complex but now trying to make simple

Analytical facilities -Insufficient

Inspection and enforcement -considerable gaps and overlapping responsibilities, Food safety authority will take care

Coordination, communication and exchange -Limited among ministries -Inefficient use of resources

Knowledge and awareness -Limited

Different Laws Related to Food Safety

The Bangladesh Food Safety Act 2013

The Bangladesh Pure Food Ordinance 1959

Bangladesh Pure Food (Amendment) Act 2005

The Cantonments Pure Food Act 1966

The Bangladesh Pure Food Rules 1967

Protection and Conservation of Fish Act 1950

Fish and Fish Products (Inspection and Quality Control) Ordinance 1983

Animal Slaughter (Restriction) and Meat Control Act 1957

Fish Feed and Animal Feed Act 2010

Agricultural Pest Ordinance 1962

The Pesticide Ordinance 1971

BSTI Ordinance and many others

Enhanced food-borne

Illness Surveillance +

capacity for FSER

Strengthening national food

analysis capacity

Enhanced public awareness &

education on FS &

consumers’ health & advocacy

Institutionalize of food safety

Strengthened preventative risk-

based controls involving different

food chain stakeholders

Strengthened capacity for

standards devt based on risk assessment

Strengthened food safety in Bangladesh

Capacity developed in

identified Subsectors of food business

Bangladesh Government has brought so far 64 food and agricultural product for mass consumption under the mandatory certification marks

ENSURING FOOD SAFETY: AN IMPORTANT CHALLENGE TODAY

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Consumers’ Role The consumers can play an important role in contributing towards food safety by-

Respecting refrigerating temperature during storage

Respecting shelf-life of the product

Preventing cross contamination during preparation of food

No undercooking of raw fish, meat or vegetables

Role of Medical Associations

As unsafe food is causing much harm to public health,Medical Associations should act as pressure groups to motivate the policy makers,beurocrates and administrators to be active in executing the law and increasing effective surveillance

As doctors’ advice is expected to be heard by all the stakeholders particularly the consumers than anyone else,Medical Associations both national and international should take active part in the campaign for safe and healthy food

Sustained and intensive behavior change campaigns

Use of traditional media (folk music, theatre), print and electronic media Targeting of special groups

Food chain participants such as producers, processors Consumers such as women, school children

Dissemination of food safety messages

Global Hand washing Day

PREVENTIVE APPROACHES TO STREET FOOD SAFETY

Pilot project with Khulna City Corporation

350 street food carts distributed

Vendors trained in good hygiene practices

RISK-BASED FOOD INSPECTION Risk based inspection of food from primary production to retailer is the key issue to ensure consumption of safe food

However, the size and complexity of the responsibilities of the inspectors is enormous

Identification of risk factors that are threatening to public health needs skill and logistics.

Food Safety Program is providing support in building national capacity to operate and manage a risk-based, coordinated food inspection.

FOOD-BORNE DISEASE SURVEILLANCE Capacity building activities (IEDCR)

Setting up hotline/SMS service Reporting food related illness Developing surveillance protocols Investigating outbreaks Collecting suspected food samples

Analysis of risk factors (NFSL) Pathogens

E. coli, Salmonella, Campylobacter, Listeria Chemical contamination

Pesticides, vet. drugs, heavy metals Additives, adulterants

Target : Develop baselines on occurrence of FBDs

PREVENTIVE APPROACHES TO FOOD SAFETY

Civil Society Organizations

supported and the BFSN*

created

Food safety behavior change communication campaign conducted

Training and manuals to improve hygiene and manufacturing practices in food industry provided

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THANK YOU FOR YOUR KIND ATTENTION !

Source: Bangladesh Statistical Year Book 2010

Child Mortality Rate would decline more rapidly if safe food could be ensured

RECOMMENDATIONS Implement Food Safety Act 2013

Formulate rules and regulations

Establish linkages between international and national activities to mutually benefit

Be prepared for emerging issues Dealing with consumer perceptions Emerging hazards and food technologies

Involve stakeholders in food safety

Share experiences

Communication

Source: Bangladesh Statistical Year Book 2010

Life Expectancy would be higher if safe food could be ensured

ENSURING FOOD SAFETY: AN IMPORTANT CHALLENGE TODAY

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